MEDITATION NEW CLIENT FORM

Hi there! I'm so excited you have decided to take the next steps towards a better and healthier you! Please take a few moments to fill out the information below and review the Terms & Conditions. I look forward to working with you! xo Vanessa Michele

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Previous Mediation Experience?

Yes

Intention

Please describe your goals and what you would like accomplish through our meditation sessions?

What is your biggest struggle or fear with meditation?

Are you a morning person or a night owl?

Morning

Night

Details

Please include session date and time preferences and any additional details/requests for your session.

Participant Informed Consent and Waiver of Liability

I acknowledge that I am voluntarily participating in Meditation sessions with Vanessa Thomas. I acknowledge and understand that I am responsible for all aspects of my health and well-being. I further recognize and understand that the instructions and advice presented to me during the sessions are in no way intended as substitutes for medical and/or other professional counselling. If I have any health concerns that may interfere with my participation in the meditation sessions, I understand that I should consult my healthcare provider before beginning the meditation exercises. If I experience pain or difficulty that is cause for concern during or after practicing the meditation exercises, I understand that I should stop immediately and consult my healthcare provider before continuing on with the meditation exercises. I recognize, understand, and assume all risks associated with my voluntary participation in the sessions, including, but not limited to, those risks that may result in personal injury and death. In giving my informed consent to participate in the guided meditation, I hereby release Vanessa Thomas from any and all claims, now or in the future, that I may have as a result of my voluntary participation in the coaching. By typing your name below and selecting the checkbox below, you are signing this agreement electronically. You agree your electronic signature is the equivalent of your manual signature on this Agreement.

I agree

MEDITATION NEW CLIENT FORM

©vanessa michele